Respiratory Tutorial in GP Flashcards
What are the key differential diagnoses for wheeze?
Key differential diagnoses for wheeze include:
Asthma: Characterized by reversible airflow obstruction.
Chronic Obstructive Pulmonary Disease (COPD): Persistent airflow limitation due to chronic bronchitis or emphysema.
Bronchitis: Inflammation of the bronchial tubes.
Foreign body aspiration: Common in children.
Heart failure: May cause wheezing due to pulmonary edema.
Vocal cord dysfunction: Non-organic wheeze, often linked to stress or respiratory irritation.
What are the key differential diagnoses for shortness of breath (dyspnea)?
Differential diagnoses for dyspnea include:
Asthma: Often associated with wheeze and cough.
COPD: Progressive breathlessness with a history of smoking.
Heart failure: Shortness of breath due to fluid accumulation in the lungs.
Pneumonia: Infection causing impaired gas exchange.
Pulmonary embolism (PE): Acute onset of breathlessness with possible chest pain.
Anxiety or panic attacks: Hyperventilation may be mistaken for dyspnea.
What are the key differential diagnoses for cough?
Differential diagnoses for cough include:
Upper Respiratory Tract Infection (URTI): Common viral infections (e.g., cold or flu).
Chronic bronchitis (part of COPD): Persistent cough with mucus.
Asthma: Cough may be the only symptom, especially at night.
Postnasal drip: Cough due to sinusitis or allergic rhinitis.
Gastroesophageal reflux disease (GERD): Cough due to acid reflux.
Lung cancer: Persistent, unexplained cough.
What are the key differential diagnoses for haemoptysis (coughing up blood)?
Differential diagnoses for haemoptysis include:
Bronchitis: Chronic or acute inflammation of the airways.
Pneumonia: Can lead to blood-tinged sputum in severe cases.
Tuberculosis: Often presents with weight loss, fever, and night sweats.
Lung cancer: Common cause of haemoptysis in adults.
Pulmonary embolism: May cause blood-tinged sputum due to infarction.
Bronchiectasis: Chronic infection and inflammation causing blood-tinged sputum.
What are the common clinical patterns and presenting features of key respiratory conditions in general practice?
Asthma: Wheezing, coughing (especially at night), chest tightness, and shortness of breath, often triggered by allergens or exercise.
COPD: Chronic cough, sputum production, progressive dyspnea, and a history of smoking.
Upper Respiratory Tract Infection (URTI): Sore throat, runny nose, cough, and mild fever.
Lower Respiratory Tract Infection (LRTI): Cough, fever, and sputum production, often associated with pneumonia or bronchitis.
Pneumonia: Sudden onset of fever, cough, pleuritic chest pain, and dyspnea.
Lung cancer: Persistent cough, weight loss, hemoptysis, and chest pain, especially in smokers
How is the clinical management of asthma, COPD, URTI, LRTI, pneumonia, and lung cancer handled in the community setting?
Asthma: Long-acting beta-agonists (LABAs), inhaled corticosteroids, and short-acting beta-agonists (SABAs) for acute relief. Patient education and monitoring of peak flow.
COPD: Smoking cessation, inhaled bronchodilators (SABAs, LABAs), corticosteroids, and oxygen therapy in severe cases.
URTI: Symptomatic management with rest, fluids, and over-the-counter medications like decongestants or antihistamines. Antibiotics are generally not used unless a bacterial infection is suspected.
LRTI: Antibiotics for bacterial infections like pneumonia; supportive care for viral infections.
Pneumonia: Antibiotics based on pathogen (e.g., amoxicillin or macrolides), supportive care, and possible hospital admission if severe.
Lung cancer: Referral to secondary care for diagnosis and staging; palliative care for symptom management if advanced.
What are commonly used clinical prediction and severity scoring tools for respiratory conditions?
Common tools include:
Asthma: Asthma Control Test (ACT) to assess symptom control.
COPD: The COPD Assessment Test (CAT), mMRC (Modified Medical Research Council) Dyspnea Scale.
Pneumonia: CURB-65 score (confusion, urea, respiratory rate, blood pressure, age ≥65) to assess severity.
PE: Wells Score for the likelihood of pulmonary embolism.
COPD and Asthma: Spirometry for diagnosis and assessing disease severity.
What are commonly used therapeutic strategies for respiratory conditions?
Non-pharmacological:
Smoking cessation (essential for COPD and lung cancer prevention).
Pulmonary rehabilitation (for COPD).
Oxygen therapy (in COPD, pneumonia, and lung cancer with hypoxia).
Chest physiotherapy (especially for bronchiectasis or cystic fibrosis).
Vaccination: Pneumococcal, influenza vaccines for at-risk populations.
Pharmacological:
Bronchodilators: Short-acting (SABA), long-acting (LABA) for asthma and COPD.
Corticosteroids: Inhaled corticosteroids (ICS) for asthma and COPD exacerbations, oral steroids for severe exacerbations.
Antibiotics: For bacterial infections in pneumonia, URTI, or LRTI.
Leukotriene receptor antagonists: For asthma management.
Antihistamines: For allergic rhinitis and URTIs.
Decongestants: For symptom relief in URTIs.
What are the commonly used classes of drugs for respiratory conditions and their side effects?
Bronchodilators:
Short-acting beta-agonists (SABA): Side effects include tachycardia, tremors, and nervousness.
Long-acting beta-agonists (LABA): Side effects include tachycardia, muscle cramps, and arrhythmias.
Corticosteroids: Side effects include oral thrush, hoarseness, and increased risk of infections.
Leukotriene receptor antagonists: Side effects include headache, abdominal pain, and dizziness.
Antihistamines: Side effects include sedation, dry mouth, and blurred vision.
Decongestants: Side effects include hypertension, insomnia, and palpitations.
How does primary care management of respiratory conditions differ from secondary care?
Primary care focuses on:
Initial diagnosis and management.
Prevention (e.g., smoking cessation, vaccination).
Continuity of care with a focus on holistic, patient-centred approaches.
Monitoring and managing stable disease (e.g., asthma control, COPD management).
Secondary care is involved when:
There is failure of primary management or complex cases (e.g., advanced lung disease, lung cancer).
Specialized diagnostic tests (e.g., bronchoscopy, CT scans).
Advanced treatments, including surgery or chemotherapy for lung cancer.
What is the approach to holistic and person-centred care in the management of respiratory conditions?
Holistic care includes:
Comprehensive assessment of the patient’s physical, emotional, and social needs.
Individualized treatment plans based on the patient’s values, preferences, and goals.
Involvement of the patient and family in decision-making.
Addressing co-morbidities and providing support for mental health (e.g., anxiety, depression in chronic disease).
Improving quality of life through symptom management and education.
